DR KUNAL MAHAJAN: few controversies....

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regards

DR KUNAL MAHAJAN

mbbs(rpgmc tanda)

md med student(pgims rohtak)

Thursday, April 8, 2010

few controversies....

ques 1) which is the drug of choice for seizures in pregnancy??? (allindia 2002)
a)sodium valproate
b)carbamazepine
c)phenobarbitone
d)phenytoin
this ques is one of the most controversial questions in aipge history with different sources giving different answers....here are few
1)mudit khanna = phenobarbitone
2)IAMS coaching =phenobarbitone
3)rxpg site = phenytoin
4)bhatia coaching = carbamazepine
5)pgi sources = carbamazepine
answer is CARBAMAZEPINE
here is the reference----- read the following lines from LAURENCE 9th EDITION PAGE 416
''with current information,carbamazepine seems to be the safest drug for use in pregnancy. Data on lamotrigine(more recently used) are increasing,but it has not been shown,to be strongly associated with malformations.''

QUES 2)which is the drug of choice for absence seizures?
a)sodium valproate
b)ethosuximide
we all know its ethosuximide....but these days some guides are saying otherwise,,even some coaching institutes say valproate,mainly because in harrison table for treatment of epilepsy,,valproate has been written over ethosuximide in the table....but nowhere in harrison it is mentioned that valproate is the drug of choice...if anybody finds this statement in any other book,,please update here...till then go with ethosuximide because i have got a standard text book ref for that...read on
page 387 katzung pharma 10th edition
''valproate is very effective against absence seizures.Although ethosuximide is the drug of choice when absence seizures occur alone,valproate is preferred when the patient has concomitant generalised tonic clonic attacks.The reason for preferring ethosuximide for uncomplicated absence seizures is valproate's idiosyncratic hepatotoxicity.''
so when asked DOC for absence seizures= ethosuximide
DOC for complicated/mixed/resistant absence seizures = valproate